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Thank you for taking 3 minutes of your time to fill out the survey.
Your responses will help us grow and make our healthcare more comfortable and enjoyable for you.

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* Nama / Name

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* Nomor Ponsel / Phone Number (+62)

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* Alamat email / Email address

***Saya setuju bahwa data dan segala informasi yang saya berikan dalam umpan balik ini adalah menjadi milik dan akan disimpan oleh PT Bundamedik Tbk dan/atau anak usahaannya dan/atau pihak lain yang ditunjuk oleh PT Bundamedik Tbk.

***I agree that the data and all information that I provide in this feedback is owned and will be stored by PT Bundamedik Tbk and/or its subsidiaries and/or other parties appointed by PT Bundamedik Tbk.
 
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